Can a flare be averted

[ancientprune]

I've had PMR for 6yrs. with several flares. Now down to 5 mgs. .pred for 5 wks. and felt reasonably o.k. but noticing muscle twinges in arms lately. Today shoulder and chest on left side are really complaining. Had planned to stay at 5 mgs until after the holidays but now I'm afraid of a flare. There's been a flurry of family affairs which have probably been stressful for my 88yr old body that thinks it's50. Can a flare be averted by upping dose a mg or two or should I go up and start over again. Lot of fatigue which I attributed to adrenals trying to wake up. Rheumy doesn't do any thing but order meds from pharmacy, talk to him 5 mins. by tele-med and have an appt. in person in 5 mos. Your advice is most helpful and deeply appreciated. Thank you.

[PMRpro Ambassador]

Our recommended approach for a flare due to having overshot the dose you need - the most common reason for a flare, especially when it is combined with a suddenly stressful situation - is to add 5mg to the dose at which you flared for up to 2 weeks and then drop back to your previously good dose.

There is very rarely any need to go back to the start but many doctors do so, increasing the amount of pred the patient takes in the end and the time it takes to taper. We don't think it should be like that.

[ancientprune in reply to PMRpro]

Thank you for the quick advice. I'll be having family Christmas and don't want to be unable to enjoy it. I hope it will help with my back as well. Again, thank you.

[PMRpro Ambassador in reply to ancientprune]

Speaking from recent personal experience - have you had your back looked at other than blaming it directly on PMR? Earlier in the year my rheumy did a steroid injection for sacroiliac pain - and since then, it has improved steadily but trochanteric bursitis and related low back pain persisted. This week he did 2 more injections targeted at them - and for the first time for years I have almost no pain and can move freely. I hope it lasts as long as the first injection has!!

[ancientprune in reply to PMRpro]

Two yrs ago I had a compression fracture of lower back. It affected L3 and L4 but neither rheumy or spine doc did anything, just let it heal so perhaps that could have something to do with the pain that comes and goes.

[PMRpro Ambassador in reply to ancientprune]

I have a misshapen L3 vertebra, found by the radiologist last New Year-ish. My rheumy does a spinal x-ray any time I develop new back pain but this is the first time they have seen anything. It is a really strange shape though, not the usual wedge of a compression fracture. Anyway, he wanted me to start zolendronate infusions, which I did. I also had horrible sacroiliac joint inflammation and he did a steroid infiltration under ultrasound guidance. The back pain improved a lot quickly but not all gone but has steadily got better over time. Then last week he did 2 more steroid injections for trochanteric bursitis - and for the first time for years I am pretty much pain free. At last.